Pain Injection Therapy
How Injections Work
Pain is your body’s natural alarm signal that something is wrong. In many cases, the body's response to injury is to tense the injured area, which restricts blood flow. An increase in pain can result in increased tension and a pain-tension cycle that could be hard to overcome. Incorrect body mechanics and posture, coupled with stress, may also cause increased muscle tension and pain. People often reduce activity because of pain, may lead to gradual muscle weakness and de-conditioning, resulting in further pain.
With injection therapy, medication is injected into the area surrounding a nerve root, which reduces inflammation and relieves pain. Relief from such injections can last anywhere from a few weeks to a few months and sometimes longer, especially if therapy is used simultaneously to strengthen muscles in the back.
When physicians choose to use injection therapy, their ultimate goal is to relieve pain long enough to enable the patient to begin physical therapy.
During an injection procedure, the patient lies on their stomach to enable a C-arm fluoroscopic device to provide X-ray images of the spine. Local anesthetic may be injected into the skin and underlying tissues to reduce discomfort from the injection. Next, a needle is inserted into the epidural space, with the vertebrae serving as “landmarks.” The physician views images from the C-arm to make sure the needle is positioned correctly. The corticosteroid injection may include a saline solution or a local anesthetic. Its dosage, volume and components will vary according to each individual patient.
Once the needle enters the epidural space, a syringe containing corticosteroid solution is connected to it. After ensuring the needle is in the correct place, the solution is slowly injected. During this time, you will be able to communicate with the doctor, and the most common sensation reported is one which resembles the feeling of “pins and needles.”
There are risks involved in any operation or injection procedure. In the case of epidural steroid injections, these risks are minimal. There are some potential side effects and complications, most of which relate to the way in which the injection is administered rather than the actual steroid itself.
The most common side effect of epidural steroid injections is a temporary surge in pain, but this occurs only about 1 percent of the time and most likely relates to the volume of the injected substance. Headaches are another potential complication, with an incidence of just 1 percent. These headaches may be linked to the unintended puncture of the innermost membrane that surrounds the spinal cord. In most cases, the headache will subside within a few hours up to a day or two.
If you are allergic to any of the additives in the steroid solution, you may experience a hot flush or develop a rash. However, this should improve within a few hours or days.
As with any injection into the skin, it is possible for an infection to form if bacteria enters the puncture. However, the risk of this occurring in the case of an epidural injection is very low.
It is also possible during an injection procedure for a nerve to become damaged, causing pain to shoot through the leg. This may occur if the needle touches the lining surrounding a nerve. Use of the C-arm for guidance reduces this risk.
A patient’s blood pressure may fall at the time of an injection. If this occurs, the doctor may inject fluids and/or medication to control blood pressure. Other side effects of epidural steroid injections could occur based on the dosage of anesthetic or corticosteroid used or if the drugs are injected into the spinal fluid rather than the epidural space. However, these side effects are rare.
You are unlikely to benefit from repeated epidural steroid injections if the first or second does not provide relief. You should not receive more than three injections if none of them have helped. Even if the injections do provide relief, only in exceptional cases will more than three be recommended over a three-month period. Other injection techniques may prove helpful even if the initial approach does not provide obvious benefits. A second epidural steroid injection will not be recommended if your pain symptoms are worsened by any previous injection.
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